Provider Demographics
NPI:1295358257
Name:YU, JUDITH (PA-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9418 TWIN TRAILS DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2626
Mailing Address - Country:US
Mailing Address - Phone:909-992-2546
Mailing Address - Fax:
Practice Address - Street 1:995 GATEWAY CENTER WAY STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4545
Practice Address - Country:US
Practice Address - Phone:619-264-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant